Related to injury? I asked a patient how she was coping with pain. She stated that she continued to have significant neck, shoulder and leg pain from her fall. She then added “oh, I might as well tell you, no one else cares…my son has been arrested, my daughter is pregnant, and I am facing foreclosure. My mom is now very sick, and my boyfriend will not help financially. I cannot work so must go live with my parents even though they are dealing with mom’s illness.”
While not related in any way to an injury, such stressors are directly related to her mental status. Her anxiety, depression, sleep disturbance and focus upon her pain are proximately tied to these quality of life factors.
The most common non-injury factors that impact patients are: a. Severe financial problems b. Health problems within the family c. Addiction problems in family d. Legal problems for children and/or spouse e. Severe relationship issues with in-laws and extended families Treatment for any or all of these issues under workers’ compensation is not authorized.
Nonetheless, the patient’s coping with the aftermath of injury is impeded by these very factors. It is as if: “you have these severe problems, and you are coping poorly with your injury. So let’s not deal with them and focus solely upon that which is demonstrably and causally related to your injury.”
Patients rarely tell their surgeons of these problems. They sense that interest would be minimal; that ability to assist would be even less. They often wait for the surgeon to seem befuddled by their mental status and then call for a psychological consult. This referral, in turn, may either be denied or slow to be approved.
Drawing a line between direct work-related psychological problems and coexisting situational stressors is much like making the distinction between degenerative arthritis and an acute rotator cuff tear. One condition exacerbates the other, and neither is likely to resolve to the satisfaction of all concerned.